I read the article in Newsweek that you were interviewed for, Glenn. The way it was phrased, it made it sound like PRK was generally a safer option than LASIK. It's not as invasive, there's no flap, and vision results are generally clearer. Am I correct in saying all this? And if I am, why are those who are eligible for PRK go with LASIK instead? The quicker healing time can't be all there is to it, can it?

Your take on my comments in the article are accurate. The advantages of Lasik are short-term - very fast vision recovery and virtually no pain. The advantages of PRK are long-term - no possibility of a flap complication during surgery or the patient's lifetime. Several studies have shown surface ablation techniques like PRK, LASEK, and Epi-Lasik to have slightly better outcomes than Lasik, but the margin is rather small.

Lasik is still the most popular vision correction surgery for many reasons, but in my opinion the primary reasons are because instant gratification is still what people want and what doctors want to provide. Since Lasik flap complications are relatively rare, the decision to offer Lasik instead of PRK is considered medically appropriate. There are the marketing aspects too. Everybody knows "Lasik" and just about everybody knows someone who had Lasik and loves it. Lasik is an easy sell when compared to PRK.

What interests me the most is the extent to which vision is clearer with eyes that have undergone PRK than with LASIK. The article seemed to imply that that happened fairly often. When you say "slightly better outcomes," are you saying that this isn't true and that the difference in vision results between PRK and LASIK is not significant?

Several studies have shown surface ablation techniques reported by patients to provide better vision quality than Lasik, but the measurable results are relatively small and not all PRK eyes have better vision than Lasik eyes.

I'm a big fan of surface ablation like PRK, LASEK, and Epi-Lasik because they eliminate the Lasik flap and therefore any possibility of a Lasik flap related complication, but so far nothing has shown such a large difference in vision quality that PRK is a slam dunk.

My first and foremost concern is the long-term condition and clarity of my vision. At least I know PRK will not be any worse than LASIK.

Since I'm a student and won't be working over winter break (I figured, at age 20 with a good amount of money saved up, I'd undergo the surgery sooner rather than later), that means I'll have enough time to recuperate (~4-6 weeks, if I understand correctly). Since PRK is significantly safer and about $1000 cheaper, it definitely sounds to me like PRK is the way I'm going to go.

So what are the significant differences between PRK and the other two surface ablation surgeries you mentioned: LASEK and Epi-Lasik?

The difference between PRK, LASEK, and Epi-Lasik is what is done to the epithelium (outermost layer of soft corneal cells). In PRK, the epithelium is removed. These are the fastest reproducing cells in the human body. They regenerate covering the treatment area in 3-5 days, but take more time to thicken and smooth.

In LASEK the epithelium is disrupted with an alcohol solution, slid aside, and then spread back over the treatment area after laser ablation. The epithelial cells are mortally wounded, will die, and will be replaced like in PRK.

Epi-Lasik uses a microkeratome with a blunt blade that lifts the epithelium, it is moved aside, and then replaced over the treatment area after laser ablation. The epithelial cells are mortally wounded, will die, and will be replaced like in PRK.

Epi-Lasik and LASEK were developed as an attempt to reduce postoperative discomfort and reduce the probability of corneal haze. Several contralateral studies have not shown discomfort to be significantly changed and the haze issue is resolved with newer technology small spot lasers and topical application of Mitomycin C. A recent debate between ophthalmologists indicates that Epi-Lasik and LASEK are really not better than PRK. Outcomes are the same and the manipulation of the epithelium may be just so much expensive luggage. There are surgeons who swear that patients are better served with LASEK and Epi-Lasik, but data does not seem to support this position.

The downside to LASEK and Epi-Lasik is that the vision recovery tends to be pretty good immediately after surgery (better than PRK), goes downhill as the cells die off and are being replaced, and then comes back once the dead cells are sloughed off and the new healthy cells start to smooth the cornea.